Organization
CRUSADERS CENTRAL CLINIC ASSOCIATION
Active
Organization
CRUSADERS CENTRAL CLINIC ASSOCIATION
Active
Parent organization
CRUSADERS CENTRAL CLINIC ASSOCIATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Authorized official
PEGGYANNE DAVENPORT (CREDENTIALING ADMINISTRATOR)
(815) 490-1616
Entity
Organization
Contact information
Practice address
1100 BROADWAY, ROCKFORD, IL 61104-1429
(815) 490-1600
(815) 490-1834
Mailing address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1834
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
07/21/2023
Last updated
02/13/2025
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